Systemic capacity building: a hierarchy of needs

Health Policy Plan. 2004 Sep;19(5):336-45. doi: 10.1093/heapol/czh038.


'Capacity building' is the objective of many development programmes and a component of most others. However, satisfactory definitions continue to elude us, and it is widely suspected of being too broad a concept to be useful. Too often it becomes merely a euphemism referring to little more than training. This paper argues that it is more important to address systemic capacity building, identifying a pyramid of nine separate but interdependent components. These form a four-tier hierarchy of capacity building needs: (1) structures, systems and roles, (2) staff and facilities, (3) skills, and (4) tools. Emphasizing systemic capacity building would improve diagnosis of sectoral shortcomings in specific locations, improve project/programme design and monitoring, and lead to more effective use of resources. Based on extensive action research in 25 States, experience from India is presented to illustrate how the concept of the capacity building pyramid has been put to practical use.

MeSH terms

  • Community-Institutional Relations
  • Decision Making, Organizational
  • Europe
  • Health Care Reform / methods*
  • Health Planning / organization & administration*
  • Health Planning Technical Assistance*
  • Humans
  • India
  • International Cooperation*
  • Models, Organizational
  • Needs Assessment*
  • Systems Analysis
  • Technology Transfer